Research

Our lab studies potential links between anesthesia and postoperative complications. We currently have four major areas of research interest and study.

Pulmonary complications in long-term postoperative outcomes

Patients at higher risk of developing postoperative pulmonary complications include those with excessive obesity, those who are older adults, and those undergoing emergency and more extensive and invasive operations.

Emerging evidence shows that a protective ventilatory strategy that includes intraoperative lung recruitment maneuvers and use of individualized positive end-expiratory pressure (PEEP) may reduce the rate of postoperative pulmonary complications.

The primary objective of this research is to test the hypothesis that an individualized perioperative anesthesia-centered bundle of interventions directed toward maximizing perioperative lung expansion (recruitment maneuver and individualized PEEP, and postoperative lung expansion with early ambulation and scheduled incentive spirometry) results in a reduction in the rate of mild, moderate and severe postoperative pulmonary complications.

Impaired cognitive function after anesthesia

Impaired cognitive function after anesthesia has been observed and described in the literature. Preclinical studies even suggest a possibility for development of Alzheimer's disease neuropathology following exposure to anesthesia. In older adults, cognitive decline after anesthesia may be characterized by impairment of memory, attention, concentration and executive function.

Our lab studies the association between exposure to anesthesia in older adults and the speed of cognitive decline in the years after exposure to anesthesia. Our research also investigates other neurodegenerative outcomes in older adults and includes longitudinal assessments of structural brain MRI and brain amyloid content in participants included in the Mayo Clinic Study of Aging, a large prospective population-based study, led by Mayo Clinic neurologists, epidemiologists and radiologists.

The aims of our studies are to examine whether surgical (exposure to anesthesia) or nonsurgical hospitalizations are associated with accelerated cognitive decline (compared with nonhospitalized participants). We're specifically studying whether accelerated cognitive decline may be characterized as Alzheimer's-type dementia (as evidenced by increased burden of brain amyloid) or nonspecific neurodegeneration (absence of amyloid). Differentiating between the two pathologies has clinically prognostic importance because Alzheimer's-type dementia typically has faster deterioration.

Our ultimate goal with this research is to help older patients and their families make informed decisions about the risks of undergoing elective operations, especially for people who are already cognitively impaired before surgery.

• Read more about the Mayo Clinic Study of Aging.

Retrospective studies

We conduct retrospective studies using the Rochester Epidemiology Project to study the association between anesthesia and various neurodevelopmental and neurological outcomes, specifically Parkinson's disease in adults, and autism, attention-deficit/hyperactivity disorder (ADHD) and learning disabilities in children.

• Read more about the Rochester Epidemiology Project.

Performance improvement database

We also use an anesthesia performance improvement database to examine other relevant outcomes. For example, we investigate causes related to excessive postoperative sedation and factors and conditions associated with unexpected postoperative emergencies (activation of rapid response team).